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TENNESSEE CVS PHARMACY, L.L.C.
DSH440073 MAURY REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
MAURY REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440073
Entity Address
1224 TROTWOOD AVENUE
COLUMBIA, TN 38401
Medicare Provider Number
440073
Participating Start Date
7/20/2022
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
TENNESSEE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04365
709 W COLLEGE ST
PULASKI, TN 38478
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Martin Chaney, Chief Executive Officer
(931) 380-4008
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2025
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